1497875314 NPI number — COUNCIL ON ALCOHOL AND DRUG ABUSE

Table of content: (NPI 1497875314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497875314 NPI number — COUNCIL ON ALCOHOL AND DRUG ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL ON ALCOHOL AND DRUG ABUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497875314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 W LINDEN ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-437-0801
Provider Business Mailing Address Fax Number:
610-437-1997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 W LINDEN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-437-0801
Provider Business Practice Location Address Fax Number:
610-437-1997
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORNER
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
610-437-0801

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  391144 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007531210004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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